Provider Demographics
NPI:1336450600
Name:GRIDER, JOSEPHINE ANNE (NP)
Entity type:Individual
Prefix:MS
First Name:JOSEPHINE
Middle Name:ANNE
Last Name:GRIDER
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30600 TELEGRAPH RD
Mailing Address - Street 2:SUITE 3275
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4530
Mailing Address - Country:US
Mailing Address - Phone:248-723-9613
Mailing Address - Fax:248-723-9615
Practice Address - Street 1:30600 TELEGRAPH RD
Practice Address - Street 2:SUITE 3275
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4530
Practice Address - Country:US
Practice Address - Phone:248-723-9613
Practice Address - Fax:248-723-9615
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704104796364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM52570Medicare PIN
MIS44554Medicare UPIN